Pulmonary Rehabilitation for Affective Aspects of Dyspnea in COPD

How effective is home-based pulmonary rehabilitation in addressing dyspnea-related anxiety and distress in patients with COPD?

Interventions that target anxiety and distress associated with dyspnea should be considered as part of pulmonary rehabilitation (PR) programs, according to a retrospective study published in BMJ Open Respiratory Research.

Dyspnea affects most people with chronic obstructive pulmonary disease (COPD) contributing to fear and anxiety that may cause poor health-related quality of life. Because little is known about the affective domain of dyspnea, researchers evaluated the effectiveness of a home-based PR program on the physical and affective components of dyspnea.

In the current study, 225 patients with COPD were enrolled into a person-centric home-based PR program, consisting of weekly supervised 90-minute home sessions over 8 weeks. Patients completed the dyspnoea-12 (D-12) questionnaire, which includes breathlessness descriptors used to evaluate the physical and affective impact of respiratory diseases on activities of daily living. Participants were also assessed on characteristics that could cause changes to D-12 scores, including health status, anxiety and depressive symptoms, exercise tolerance, and general fatigue. Assessments were taken at baseline (month 0 [M0]), at the end of the PR program (month 2 [M2]), and at 8 (M8) and 14 months (M14) after M0.

Multivariable analysis of covariance (ANCOVA) models were performed to identify baseline characteristics that contributed to the change in D-12 scores. The researchers found that compared with baseline, both physical and affective components of dyspnea and all other outcome measures were improved at M2, M8, and M14 (P <.05). Baseline BMI was the only significant independent predictor of changes in the physical dyspnea score, whereas change in the affective dimension of dyspnea after PR was associated with forced expiratory volume in the first second of expiration (FEV1), anxiety symptoms, and exercise tolerance. However, these variables had only a small impact on changes in the D-12 questionnaire scores, thus these results should be interpreted cautiously.

“Both physical and affective components of dyspnoea were improved, at short term and long term, by 8 weeks of individualised home-based PR,” concluded the researchers. Thus, dyspnea should be assessed as a multidimensional experience during PR, noted the investigators, adding that further studies are needed.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Grosbois J-M, Gephine S, Kyheng M, et al. Physical and affective components of dyspnoea are improved by pulmonary rehabilitation in COPD. BMJ Open Resp Res. 2022;9:e001160. doi:10.1136/bmjresp-2021-001160